The first book for the general public about mindfulness and medical practice, a groundbreaking, intimate exploration of how doctors think and what matters most—safe, effective, patient-centered, compassionate care—from the foremost expert in the field.

As a third-year Harvard Medical School student doing a clinical rotation in surgery, Ronald Epstein watched an error unfold: an experienced surgeon failed to notice his patient’s kidney turning an ominous shade of blue. In that same rotation, Epstein was awestruck by another surgeon’s ability to avert an impending disaster, slowing down from autopilot to intentionality. The difference between these two doctors left a lasting impression on Epstein and set the stage for his life’s work—to identify the qualities and habits that distinguish masterful doctors from those who are merely competent. The secret, he learned, was mindfulness.

In Attending, his first book, Dr. Epstein builds on his world-renowned, innovative programs in mindful practice and uses gripping and deeply human clinical stories to give patients a language to describe what they value most in health care and to outline a road map for doctors and other health care professionals to refocus their approach to medicine. Drawing on his clinical experiences and current research, and exploring four foundations of mindfulness—Attention, Curiosity, Beginner’s Mind, and Presence—Dr. Epstein introduces a revolutionary concept: by looking inward, health care practitioners can grow their capacity to provide high-quality care and the resilience to be there when their patients need them.

The commodification of health care has shifted doctors’ focus away from the healing of patients to the bottom line. Clinician burnout is at an all-time high. Attending is the antidote. With compassion and intelligence, Epstein offers a crucial, timely book that shows us how we can restore humanity to medicine, guides us toward a better overall quality of care, and reminds us of what matters most.

Editorial Reviews

Review

“This book is phenomenal, and will be phenomenally useful to physicians and to all of us who are desperately in need of true health care and caring. It is hard for me to imagine a doctor reading it and not immediately recognizing, taking to heart, and implementing its messages in any number of different ways, being so commonsensical, clear, innately transformative, and healing. And it is equally hard for me to imagine that it will not energize all of us, when we find ourselves in the role of ‘the patient,’ to demand greater mindfulness from our care-givers across the board, and know what we mean by that.”—Jon Kabat-Zinn, author of Full Catastrophe Living and Mindfulness for Beginners

“As a student admissions committee member reviewing Ron Epstein’s application to medical school, I knew he was special, a view surpassed by his visionary achievements illuminating the important nature of how physicians care for their patients, and how they can best care for themselves. Attending is the book every medical caregiver needs to strengthen their minds and harness their resilience to care for others—and every patient needs to understand how doctors think. This is a work of heart and head, a beautiful synthesis of inner wisdom and hard earned scientific empirical findings that point the way to proven methods for improving the lives of both giver and receiver of medical care. With clear explanations, captivating stories, and well-described challenges and approaches to their solutions, this book is exactly what the field of medicine needs.”—Daniel J. Siegel, M.D., author of Mind and The Mindful Brain and Executive Director, Mindsight Institute Founding Co-Director, UCLA Mindful Awareness Research Center

“I recommend Attending for anyone interested in health. In a most accessible way, Epstein makes a very convincing case for how doctors and patients would prosper from doctors becoming more mindful.”—Ellen Langer, PhD, Professor of Psychology, Harvard University, author of Mindfulness and Counterclockwise: Mindful Health and the Power of Possibility

“This powerful and inspiring book opens the pathway to bringing care, wisdom, and mindfulness into practice of medicine. A must-read for all clinicians and for lay readers as well.”–Joan Halifax, PhD, author of Being With Dying

“Ronald Epstein cuts through the cacophony and illuminates the heart of the medical enterprise—the attentive and compassionate connection between doctor and patient. In a world awash with medical error, patient dissatisfaction, and burned-out doctors, this attention to mindfulness is much needed balm. Attending is at once penetrating, counterintuitive, and profoundly humbling.”–Danielle Ofri, MD, PhD, author of What Patients Say, What Doctors Hear

“Attending got my attention from the opening paragraphs. Beautiful, compelling, and wise stories of how medicine and care-taking can be, (should be) when approached with common sense, a fierce sense of what is best for both the doctor and patient, and a compassionate heart. A timely and important book!”–Marc Lesser, CEO of Search Inside Yourself Leadership Institute (SIYLI) and author of Know Yourself, Forget Yourself and LESS: Accomplishing More By Doing Less

“Ronald Epstein truthfully and powerfully describes the challenging and changing worlds of both the physician and and the patient. Attending will encourage the recognition that mindfulness and compassion training contribute to effective medicine. The book clearly demonstrates how these contemplative practices can help enrich the lives of everyone involved in health care.”–Sharon Salzberg, author of Lovingkindness and Real Happiness

“Epstein presents for general readers a concise guide to his view of what mindfulness is, its value, and how it is a skill that anyone can work to acquire.”–Library Journal

“A deeply informed and compassionate book…[Dr. Epstein] tells us that it is a ‘moral imperative’ to do right by our patients. And he shows why and how.”--Lloyd Sederer, New York Journal of Books

“Vivid… Epstein’s candor and courage…that makes the book so compelling.”–Pharos

“Among the best books about how to teach the humanistic aspects of doctoring. Epstein weaves together an insightful collection of experiences that examine the clinician’s situation starting from inside her own mind and ending at the system in which she practices.”–Gold Foundation

“Thoughtful company in times when we’ve never needed thoughtful company more.”–Harvard Medicine

About the Author

Dr. Ronald Epstein is a practicing family physician, is a professor of family medicine, psychiatry, and oncology at the University of Rochester School of Medicine and Dentistry, where he directs the Center for Communication and Disparities Research and codirects Mindful Practice programs. He is an internationally recognized educator, writer, and researcher whose landmark article, “Mindful Practice,” published in the Journal of the American Medical Association in 1999, has revolutionized physicians’ view of their work. Dr. Epstein has been named one of America’s Best Doctors every year since 1998 by U.S. News & World Report. Visit Dr Epstein at RonaldEpstein.com.

Thanks to Net Galley and to Scribner for providing me with an ARC copy of this book that I freely chose to review.

If they asked me to provide a single word review of this book, I would write AMEN.

Ronald Epstein, the author and practising doctor with his own clinic, after years of studying a variety of disciplines (including music, meditation, Philosophy, Zen, Medicine…) and of trying to find the best way to maintain a practice sensitive to the needs of patients, compassionate, focused on well-being and avoiding suffering, rather than on billing, money and the business-side of things, published an article called ‘Mindful Practice’ in 1999. The article was very well received and resulted in the author becoming a speaker and offering training to other health professionals, emphasising the important of being mindful of one’s practice. In this book, the author shares his insight and knowledge to help other physicians avoid errors, burnout, and remember what Medicine should really be about. He offers plenty of background research and information (with abundant notes that take up more than a third of the book and a useful bibliography for those who want to check the original sources) interspersed with case stories that illustrate the topics. These include cases Dr Epstein had personal experience of (both as a physician and as a patient) and others that he’s accumulated over years of educating other professionals and talking to friends and colleagues. These cases not only reinforce the theoretical points but also add a practical and personal touch that can be lost in purely theoretical texts.

The book is written in a fluid and clear style, accessible and interesting also to those who might not work in healthcare, although it is particularly geared towards health professionals. Due to the themes and subjects touched upon, this book would be useful to individuals and institutions heavily invested in helping people and dealing with the public, in particular, those offering care. Although many of the reflections are particularly pertinent to individuals, the emphasis on education and the fact that many of the qualities discussed, like compassion and resilience can be taught, are particularly important for organisations and institutions that manage human resources. As Dr Epstein explains, they would go a long way to help avoid professional burnout.

Although Attending mentions Zen, neurocognitive studies, philosophers’ books, mindfulness and meditation, the overall message does not require an in-depth knowledge of any of those subjects and I cannot imagine anybody who would not find something useful in this volume.

As a doctor and one who left the job a few years back less than enamoured with the way health care is organised, I kept nodding all the way through. I highlighted so many sentences and quotes that I cannot share them all, but I will choose a few ones that I felt were particularly pertinent:

Medicine is in crisis. Physicians and patients are disillusioned, frustrated by the fragmentation of the health care system. Patients cannot help but notice that I spend more and more time looking at computer screens and less time face-to-face. They experience the consequences of the commodification of medicine that has forced clinicians’ focus from the healing of patients to the mechanics of health care —productivity pressures, insurance regulations, actuarial tasks, and demoralizing metrics that measure what can be counted and not what really counts, sometimes ironically in the name of evidence-based and patient-centered care.

Maslach found that burnout consisted of three factors: emotional exhaustion, depersonalisation (treating people as objects), and a feeling of low personal accomplishment.

But now, in the age of the corporatization and widgetization of medicine, there is a new kind of burnout, a slow, relentless “deterioration of values, dignity, spirit and will” that comes from the structure of health care itself.

The problem is not only overwork; it’s a crisis of meaning, resilience, and community.

As I said, I think this book should be required reading for medical students, qualified doctors and also for other professionals working in healthcare and those who manage staff and organise the educational programmes of institutions, not only those providing healthcare but also any that deal with the public and its problems on a regular basis.

If I were to make a suggestion, it would be that the book could easily be made even more relevant to other disciplines by adding examples pertaining to other professions (not only nurses or paramedics but also social workers, counsellors, teachers…). It is clear from the content that although the principles can be applied individually, organisations would also do well adopting the ideals and attitudes highlighted by the research. Becoming attentive, compassionate, curious and mindful would help patients and staff increase their wellbeing and avoid burnout and complaints.

I recommend this book to all healthcare professionals, and those interested in how to improve healthcare and increase the resilience and wellbeing of staff. I think that anybody could potentially benefit from this book, and I’d recommend checking the sample if you think it might help you. I will definitely recommend it to some of my previous work colleagues.

Thanks to Scribner and to the author, thanks to all of you for reading and remember to like, share, comment and CLICK! And don’t forget to leave a review if you read a book.

I was born in Barcelona and have lived in the UK for many years now. I'm a writer, translator (English-Spanish and vice-versa) and I'm a medical doctor and worked in Forensic Psychiatry many years. I also have a BA and a PhD in American Literature and Film, and a Masters in Criminology. I've always loved books and apart from writing them I review them often.
I write a bit of everything, check my books for more information and my about page for links.
My blog is bilingual, English and Spanish.

This took me back to my time as an EMT. I was surprised at the start, to hear doctors refer to people by their problem. “I’ve come to see the tib and fib.” or, “Which cubicle is the sub-arachnoid in?” After a while, I began to see how overwhelmed they were, and learned of the long hours they worked. (48 straight on a weekend, with little sleep) Small wonder they couldn’t take time to learn the names of the patients.
‘Mindfulness’ seems to be the ‘big thing’ these days, so I suspect this book will do well.
Best wishes, Pete.

Thanks, Pete. Yes, it is true that for outsiders it might be difficult to understand the system of communication of the medical profession. I was quite sceptical about mindfulness until I attended a workshop for psychiatrists’ a few years back and, although I wouldn’t say it has changed my mind, it’s true that it has helped me try and take things more calmly.

At the same time as I buy a copy for myself, I shall probably buy a copy for every Tory politician (and a fair few others, including back-biting Labour ones) so he or she can kick-start their empathetic and selflessness muscles back into action. If, heaven forfend, they win the election, it may be the only way to get them to pull back on all the cuts that are ruining people and society, not to mention the increasing death toll their policies have caused. If Corbyn wins through, the Tories will have something to read in Opposition that should give them pause for thought. You can probably tell that I’m almost more exercised by this election than by my heart condition! (Had the second echocardiogram this morning so now it’s the waiting game.)

I hope the results of the tests are good, Sarah, but I share your feelings about the NHS. I am more and more worried about how determined they seem to destroy it. It is not a matter of individual staff propping it up and trying to do their best. It is impossible to fight the lone battle against such odds, however hard everybody in the front line tries. Let’s hope. And all the best with your health, Sarah. I’m thinking of you.

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